NPIMap

Organization Active NPI

North Penn Comprehensive Health Services

Doing business as Sullivan County Laurel Health Center

  • Federally Qualified Health Center (FQHC)
  • Laporte, PA
National Provider Identifier
1093520587
Registry record updated Feb 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTH PENN COMPREHENSIVE HEALTH SERVICES
Doing business as
Sullivan County Laurel Health Center
Practice address
217 King St
Laporte, PA 18626
Phone
(570) 946-5201
NPI assigned
Feb 11, 2025
Last updated
Feb 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ronald Meryl Gilbert
Title
Cfo
Phone
(570) 828-3869

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

217 King St
Laporte, PA 18626

Mailing address

40 W Wellsboro St
Mansfield, PA 16933-1411
Phone (570) 662-1945

Other names 1

  • Sullivan County Laurel Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040416000152 PA Part B Supplier - Clinic/Group Practice 0446245880 Receives reassigned benefits from 67 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mansfield, PA; Westfield, PA; Wellsboro, PA; Troy, PA; Towanda, PA; Blossburg, PA; Elkland, PA; Lawrenceville, PA…
O20250602002163 PA Part A Provider - Federally Qualified Health Center (FQHC) 0446245880 Practice locations: Laporte, PA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093520587. Details of each certification follow.

Federally qualified health center certification: CCN D31037

Legal name
NORTH PENN COMPREHENSIVE HEALTH SERVICES
Doing business as
SULLIVAN COUNTY LAUREL HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 4, 2025
Last certification
Apr 4, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
217 King Street
Unit 3
Laporte, PA 18626

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
North Penn Comp Health14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

245 Main St
Blossburg, PA 16912
Phone (570) 538-2174

346 York Ave
Towanda, PA 18848
Phone (570) 265-3996

105 West Ave
Wellsboro, PA 16901
Phone (570) 723-0620

15 Meade St
Ste L4
Wellsboro, PA 16901
Phone (570) 724-5200

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Scott D Myers Individual Corporate DirectorBoard Member Apr 1, 2025
John Dennis Murray Individual Corporate Director Jul 1, 1986
Donna R Wilson Individual Corporate OfficerSecretary Jun 1, 2013
Sean Sember Individual Corporate Director Sep 22, 2021
James a Nobles Individual W-2 Managing EmployeePresident & Ceo Mar 5, 2018
Thomas Thompson Individual Corporate OfficerTreasurer Jul 1, 2022
Jody Thomas Individual Corporate OfficerVice Chairperson Jul 1, 2019
Megan Wells-Williams Individual Corporate Director Jul 7, 2021
Kelly Irwin Individual Corporate Director Jul 1, 2023
Ronald M Gilbert Individual W-2 Managing EmployeeChief Financial Officer Aug 14, 2015 100%
Kimberly Johns Individual Corporate Director Jun 29, 2022
Kristopher Kaufman Individual Corporate Director Jul 1, 2022
Darla Bortz Individual Corporate DirectorBoard Member Apr 1, 2025
Jason Krise Individual Corporate OfficerChairman Jul 1, 2021

Practitioners & affiliated clinicians

Practitioners 74

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 74

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1739232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740096000000",
    "number": "1093520587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 W WELLSBORO ST",
            "city": "MANSFIELD",
            "state": "PA",
            "postal_code": "169331411",
            "telephone_number": "570-662-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 KING ST",
            "city": "LAPORTE",
            "state": "PA",
            "postal_code": "18626",
            "telephone_number": "570-946-5201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH PENN COMPREHENSIVE HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-11",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-18",
        "status": "A",
        "authorized_official_last_name": "GILBERT",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "MERYL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "570-828-3869"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sullivan County Laurel Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sullivan County Laurel Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laporte, PA

Sources for this page

Verify at the official NPI Registry.